SIRT Approved for Routine Commissioning on the NHS

Monday 01 April 2019
NHS England have announced that selective internal radiation therapy (SIRT) using yttrium-90 microspheres will be routinely commissioned for NHS patients with advanced colorectal cancer that has spread to the liver and is not responding to standard chemotherapies. The treatment will be available from April 2019.

London, England (1 April 2019) 

The use of SIRT in the NHS was assessed by NHS England from January 2014 to March 2017, as part of their Commissioning through Evaluation (CtE) scheme and the results of the assessment were published by NICE and NHS England in October 2017.

The findings were also published online as a full scientific paper in the journal Clinical Oncology by Professor Sharma and his colleagues in September 2018, which confirmed that the real-world experience of SIRT in the NHS is consistent with the published literature.1

Since 2017, NHS England has been considering the case for routine commissioning of SIRT and they have reached the conclusion that the evidence base on SIR-Spheres® resin microspheres is sufficient to offer SIRT as a routine treatment for patients with colorectal cancer that has spread to the liver who meet certain criteria.

In the Clinical Commissioning Policy paper: Selective Internal Radiation Therapy (SIRT) for chemotherapy refractory / intolerant metastatic colorectal cancer (adults), NHS England recommends that adults with chemotherapy refractory or chemotherapy intolerant unresectable, liver-only metastatic colorectal cancer that meet all of the eligibility criteria will be able to be treated with SIRT using yttrium-90 microspheres.2

Patients with advanced bowel cancer will have to meet certain criteria to be eligible for the treatment on the NHS. Specialist liver centres in England which satisfy the criteria specified by NHS England will be able to routinely offer this procedure.

“The decision by NHS England to locally commission SIRT from April is an enormous relief for patients with bowel cancer that has spread to the liver. These patients often need disease control within the liver and have limited treatment options. As long as patients meet NHS England’s clinical criteria for SIRT, treated in expert liver centres - there is likely to be benefit in controlling the liver spread.” said Dr Harpreet Wasan, Consultant in Medical Oncology, London. Dr Wasan was co-chief investigator for the FOXFIRE trial of SIRT in liver metastases.

The liver metastases should be inoperable, and the disease should not be responding to standard chemotherapies. For patients with other cancers that may benefit from SIRT, such as primary cancers of the liver, the policy proposals are still being reviewed.

Patients who do not qualify for this treatment by the NHS criteria may be able to receive SIRT by participating in a clinical trial, by submitting Individual Funding Requests via their Oncologist, or pay for it privately.

“In specialist centers we have the possibility to treat patients with innovative treatments such as SIR-Spheres Y-90 resin microspheres which is a unique way to treat liver tumours with internal radiation therapy without damaging the healthy liver. It is great news that we have now the possibility to discuss this treatment option during the multidisciplinary team meetings for all patients who could benefit from it (meeting eligibility criteria)” stated Dr Jon Bell, Consultant Interventional Radiologist at the Christie NHS Foundation Trust, Manchester.

Professor Ricky Sharma, Consultant Radiation Oncologist, Chair of Radiation Oncology at University College London, commented: “We are delighted by this announcement. Our study has confirmed that the real-world experience of SIRT as a cancer treatment in the NHS is consistent with the published data from other countries. There is still scope for improving access to this specialist treatment for patients with a variety of cancers, not just bowel cancer, and across all the nations of the UK, not just England.”

“The NHS England decision to fund internal radiation therapy to treat liver tumors is a significant development that offers new hope for patients with aggressive bowel cancer. We were very concerned for those patients who needed the treatment but who were unable to fund it privately or raise funds to receive it. Patients in England with liver cancer that has spread from their bowel and who have exhausted other treatments, now have access to a therapy which can extend their survival so that they can spend extra time with their loved ones and enjoy more life. These patients have very few treatment options, so this is a really important step” said Vanessa Hebditch Director of Policy at the British Liver Trust.


About Colorectal Cancer

Colorectal cancer is the third most frequently diagnosed cancer worldwide, and the second leading cause of cancer deaths, taking almost 900,000 lives annually.3

More than half of all patients with colorectal cancer will be diagnosed with metastases, most commonly in the liver.4,5


What is SIRT with SIR-Spheres Y-90 resin microspheres?

SIRT with SIR-Spheres Y-90 resin microspheres is a prescription device for the treatment of inoperable liver tumours. It is a minimally-invasive treatment that delivers high doses of high-energy beta radiation directly to the tumours. SIRT is administered to patients by interventional radiologists, who infuse millions of radioactive resin microspheres (diameter between 20–60 microns) via a catheter into the liver arteries that supply blood to the tumours. By using the tumours’ blood supply, the microspheres selectively target liver tumours with a dose of radiation that is up to 40 times higher than conventional radiotherapy, while sparing healthy tissue.

SIR-Spheres Y-90 resin microspheres are approved for use in Argentina, Australia, Brazil, the European Union (CE Mark), Switzerland, Turkey, and several countries in Asia for the treatment of unresectable4 liver tumours. In the US, SIR-Spheres Y-90 resin microspheres have a Pre-Market Approval (PMA) from the FDA and are indicated for the treatment of unresectable metastatic liver tumours from primary colorectal cancer with adjuvant intra-hepatic artery chemotherapy (IHAC) of FUDR (floxuridine).


About Sirtex

Sirtex Medical Limited (ASX: SRX) is an Australian-based global healthcare business working to improve treatment outcomes in people with cancer. Our current lead product is a targeted radiation therapy for liver cancer called SIR-Spheres Y-90 resin microspheres. Approximately 92,000 doses have been supplied to treat patients with liver cancer at more than 1230 medical centres in over 40 countries. For more information, please visit www.sirtex.com.


SIR-Spheres® is a Registered Trademark of Sirtex SIR-Spheres Pty Ltd.

 

References:

1. White J, Carolan-Rees G, Dale M, Morgan HE, Patrick HE, See TC, Beeton EL, Swinson DEB, Bell JK, Manas DM, Crellin A, Slevin NJ, Sharma RA. Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases. Clin Oncol (R Coll Radiol). 2018 Oct 5. pii: S0936-6555(18)30438-2. doi: 10.1016/j.clon.2018.09.002.
2. Clinical Commissioning Policy: Selective internal radiation therapy (SIRT) for chemotherapy refractory / intolerant metastatic colorectal cancer (adults). NHS England Reference: 170102P - https://www.england.nhs.uk/wp-content/uploads/2018/12/Selective-internal-radiation-therapy-for-chemotherapy-refractory-intolerant-metastatic-colorectal-cancer.pdf. Last accessed 10th January 2019
3. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, accessed [20/02/2019].
4. Adam R, De Gramont A, Figueras J et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 2012; 17: 1225–39.
5. Van de Eynde M, Hendlisz A. Treatment of colorectal liver metastases: A review. Rev Rec Clin Trials 2009; 4: 56–62.


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